| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
13,442 |
13,154 |
$405K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,747 |
13,465 |
$286K |
| D0120 |
Periodic oral evaluation - established patient |
8,426 |
8,272 |
$274K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,294 |
2,066 |
$256K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,372 |
454 |
$189K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,390 |
3,293 |
$139K |
| D9420 |
|
400 |
358 |
$115K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,733 |
930 |
$114K |
| D9920 |
|
3,847 |
3,776 |
$71K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,043 |
497 |
$57K |
| D0272 |
Bitewings - two radiographic images |
5,700 |
5,557 |
$56K |
| D0601 |
|
6,217 |
6,098 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
7,028 |
6,716 |
$48K |
| D1351 |
Sealant - per tooth |
2,048 |
579 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
1,307 |
1,286 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
2,639 |
2,437 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,903 |
5,611 |
$29K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,476 |
1,331 |
$26K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
330 |
159 |
$19K |
| D0602 |
|
1,996 |
1,967 |
$16K |
| D0603 |
|
1,486 |
1,460 |
$13K |
| D0274 |
Bitewings - four radiographic images |
743 |
717 |
$8K |
| D1110 |
Prophylaxis - adult |
230 |
227 |
$6K |
| D0330 |
Panoramic radiographic image |
400 |
386 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
62 |
20 |
$4K |
| D9310 |
|
95 |
92 |
$3K |
| D2140 |
|
31 |
15 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
38 |
38 |
$1K |
| D7111 |
|
26 |
13 |
$790.00 |
| D0190 |
|
146 |
146 |
$730.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
282 |
264 |
$271.00 |
| D1999 |
|
411 |
397 |
$0.00 |
| D1330 |
|
6,997 |
6,802 |
$0.00 |
| D1310 |
|
6,950 |
6,760 |
$0.00 |